In-hospital outcomes of very elderly patients (85 years and older) undergoing percutaneous coronary intervention.
Journal - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (United States )
To compare in-hospital outcomes of a large cohort of very elderly patients (age = 85 years) with younger patients (age < 85 years) undergoing percutaneous coronary intervention (PCI) for all indications at our institution.Interventionist cardiologists are often reluctant to undertake PCI in very elderly patients due to the perception of poor outcome in this high-risk cohort. However, the prognostic significance of advanced age itself is not clear.Baseline clinical, angiographic and procedural variables, and in-hospital outcome data were entered into a prospective registry of 17,572 consecutive patients undergoing PCI at the University Health Network between April 2000 and December 2008. Patients were stratified according to age (< 85 years, n = 17,168, or = 85 years, n = 404) and in-hospital mortality, major adverse cardiac events (MACE), and complication rates were calculated. Logistic regression-analysis identified independent predictors of unadjusted mortality and MACE. Very elderly patients were propensity matched with younger patients (1:2 ratio), and the analysis repeated.Very elderly patients had a mean age of 87.5 ± 2.9 (range, 85-97 years) vs. 62.8 ± 11.1 years for the younger cohort and had a greater number of comorbid conditions. This cohort were more likely to present as an urgent or primary PCI, underwent more complex interventions, and achieved less angiographic success. Unadjusted mortality and post procedure myocardial infarction were significantly higher in very elderly patients (6.93% vs. 1.20%, P < 0.0001 and 4.46% vs. 2.74%, P = 0.04). Renal, neurological, and access-site complications were all greater in the very elderly cohort. Although age = 85 years was a significant independent predictor of both mortality (OR, 2.62; CI, 1.44-4.78, P = 0.0016) and MACE (OR, 1.94; CI, 1.25-3.01, P = 0.003), other variables such as cardiogenic shock were more potent predictors of adverse outcomes.Very elderly patients represent a high-risk cohort, with significantly increased in-hospital mortality and complication rates after PCI. Death occurred predominantly in very elderly patients undergoing nonelective PCI. Decisions to proceed with PCI in very elderly patients should be based on other prognostic variables in combination with advanced age, and these patients should not be excluded from revascularization based on age alone.Copyright © 2011 Wiley-Liss, Inc.
|ISSN : ||1522-726X|
|Mesh Heading : ||Age Factors Aged Aged, 80 and over Angioplasty, Balloon, Coronary Coronary Angiography Coronary Artery Disease Female Hospital Mortality Humans Logistic Models Male Middle Aged Myocardial Infarction Odds Ratio Patient Selection Propensity Score Registries Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome mortality mortality radiography etiology|
|Mesh Heading Relevant : ||Aging Inpatients adverse effects therapy|
A calcified neointima--"stent" within a stent.
Journal - The Journal of invasive cardiology (United States )
De novo atherosclerosis arising within a coronary stent is rare and generally occurs many years after stent deployment. We describe a case of restenosis in a patient presenting with angina 8 years after original stent deployment. Intravascular ultrasound greyscale imaging and virtual histology demonstrated that this "neointima" was calcified.
|ISSN : ||1557-2501|
|Mesh Heading : ||Aged Angioplasty, Transluminal, Percutaneous Coronary Calcinosis Coronary Angiography Coronary Restenosis Coronary Vessels Humans Male Neovascularization, Pathologic Ultrasonography, Interventional methods therapy therapy pathology ultrasonography therapy|
|Mesh Heading Relevant : ||Stents ultrasonography ultrasonography ultrasonography|
Contemporary management of pregnancy-related coronary artery dissection: A single-centre experience and literature review.
Journal - Experimental and clinical cardiology (Canada )
Spontaneous coronary artery dissection (SCAD) is an infrequent event that is most commonly associated with pregnant women or those in the postpartum period. Because of its rarity, the literature describing this condition is confined to sporadic case reports, with few reporting long-term follow-up, and no clear consensus exists on the optimal treatment strategy for these patients. The present article reports a single-centre experience with SCAD, highlighting the issues surrounding its management with a brief description of five cases of pregnancy-associated coronary dissection. The treatment used in these cases ranged from a conservative medical approach to surgical and percutaneous intervention, with one patient proceeding to transplantation. Four of the cases have long-term angiographic follow-up.In addition, a comprehensive review of all previously published cases is presented, and temporal trends in the management strategy are highlighted. Possible pathophysiological mechanisms pertaining to this condition, and the complex diagnostic and therapeutic issues involved, which may affect both patient and fetus, are discussed. Finally, an optimal approach to patients with SCAD, informed by our experience and literature review, is described.